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Snakes and bladders

The last time I went to Greece was on my first ever trip overseas 38 years ago. I went back in May.

A highlight was Epidaurus where the World Heritage-listed ruins of the most important sanctuary of Asclepius can be found.

Asclepius, a god, the one with the snake entwined around his staff, and often with a dog, was the son of Apollo and came to represent a new generation of a more scientific approach to medicine at the end of the sixth century BC.

This replaced the earlier versions that had been more mythically based.

Asclepia ‘functioned as sacred hospitals, nursing homes, centres of religious worship and of popular entertainment’ (Snakes, dogs and dreams).

The later Hippocratic Oath from 460 – 370 BC stated, in part, ‘I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgement this oath and this covenant’.

We can glean much from worksite visits

In 1990 I worked on a manuscript on the history of medicine, unfinished I am afraid to report. Needless to say I read a lot about the medicine of Ancient Greece, and made sense of it as follows: people would go to sleep at the temple and when they awoke a priest would interpret their dreams to make a diagnosis, and then treat them.

Patchy at best, and I never could quite understand what role the snakes played.

As we know well in workplace health and safety you glean much from a worksite visit.

I learned a lot from my inspection of Asclepius’ workplace at Epidaurus and its museum.

It turns out Ancient Greeks probably had hallucinogens and sedatives, so that explains the ‘sleep’.

The museum contained surgical instruments, including for removing stones from the bladder. Next to the rectangular temple in the sanctuary used by the public was a round building, which the priests occupied. The configuration of the rotunda’s foundations has led archaeologists to suggest this is where the snakes were bred, and it is surmised they slithered about while the patients slept.

What I found most intriguing was our guide told us that patients had to be deemed ready for treatment before they entered the temple.

This struck a chord with me.

I am currently involved in work on how to boost self-efficacy in claimants in personal injury and compensation benefit systems.

Several years ago I led some research which took training in health literacy for people with chronic disease, and adapted the program for self-management support for people with chronic musculoskeletal disorders who were receiving workers’ compensation benefits.

In other words, helping people navigate the insurance and return-to-work system, as opposed to the health services system.

We were unable to demonstrate a significant difference between our test group and the control, but it was clear to the research team that self-management support interventions had potential.

Readiness for change is vital

We concluded the readiness for change was important.

For example, if training, information or peer support was offered too early after becoming unwell, injured workers may not yet be ready to be a more active participant in their recovery; too late, and they may be experiencing significant secondary psychological problems, that created barriers to their participation.

We concluded using one of the tools available to screen for readiness for change was worth considering. One of the key researchers on the project took those ideas and further developed them with IPAR, a vocational rehabilitation services company. Their program, Positivum, is being evaluated, with promising results.

We have included employee awareness as a priority area in the Collaborative Partnership to Improve Work Participation (OHN 14/03/18). Foundation partner EML is leading this stream of work.

The project proposes to draw together examples of the emerging practices that are starting to pop up, and consider them in light of an evidence-based conceptual framework.

As always there is much to be learned from the holistic approach to health and healing of our ancient forebears – the real inventors of the biopsychosocial model. But this time round, maybe lose the snakes.